1. Field of Invention
The present invention relates generally to surgical instruments, and more particularly to a complete skin biopsy apparatus which first guides the path and depth of incision and then closes the wound without the use of sutures.
2. Discussion of Prior Art
As is well known in the art, it is often necessary to excise a sample of skin for further histologic study. Traditionally, this surgical procedure was performed "free-hand" by a surgeon using a scalpel. An incision was made about the lesion to create an island of skin that was then lifted by forceps to expose the underlying tissue. The underlying tissue was then cut away, such that the sample of skin could be removed. Finally, the wound was sutured.
Ideally, an elliptical incision of uniform depth was made (the depth was chosen according to skin thickness, as it relates to location on the human body). The elliptical shape and constant thickness of the wound allowed opposing sides of the wound to be drawn together with minimal stretching or distortion of the skin. The result was accelerated healing, and reduced visible scarring.
Further improved healing and reduced scarring could be realized by a pinching and an eversion of the wound upon closure. Pinching the wound together such that the surfaces brought into apposition tended to bunch and roll upward, imposed compressive stresses proximal to the wound that would balance the natural tendency of the wound to pull apart. This permitted the skin tissues near the seam to relax while maintaining adequate pressure within the seam itself. The result was a very thin scar. A wound that had not been so addressed would tend to pull apart at the seam during healing, relying on scar tissue to fill the wider gap. In addition, the rolling upward, or eversion of the skin tissue insured that the outermost layer, or epidermis would not interfere with healing. If epidermis were trapped in the wound, a valley-like scar could result.
While the biopsy procedure required only a few steps to complete, it was difficult for the surgeon to make an ideal incision that would form the basis for optimum healing upon closure. A good deal of skill was also required in closing the wound if all of the previously mentioned features where to be incorporated for optimum healing and minimal scarring. The problem of suture tracks, or scars left by the suture wounds, is a necessary drawback of sutured closures.
While solutions specific to the problem of making an accurate elliptical incision exist in the prior art, none of these inventions address closure of the wound. An example of such a solution is depicted in U.S. Pat. No. 5,183,053 issued to Yeh et al., which shows a biopsy punch with an elliptical blade. The Yeh invention seeks a solution to the problem of an accurate incision, but in no way does it address closure of the wound.
Alternatives to conventional sutures as a means of general wound closure (not biopsy wounds specifically) are suggested in the prior art as well. U.S. Pat. No. 5,176,703 issued to Peterson depicts a sutureless closure with a means for "mounding the flesh" together for the purpose of improved healing. This closure is appropriate only for generally elongate wounds, and not for biopsy wounds. The biopsy wound is elliptical in shape and would require a bandage that conforms to this shape. Furthermore, the size of the typical biopsy wound would require a bandage, or bandages, of such small size that manipulation of the wound and the dressing would be difficult. Finally, these general wound closures in no way serve as an aid to making the initial biopsy incision.
As evidenced by the prior art, there is a need for solutions to the problems and difficulties associated with the two primary aspects of the biopsy procedure, namely the aspect of achieving a proper incision, and the aspect of achieving a proper closure. No single prior art provides a comprehensive solution to all of the problems associated with the skin biopsy procedure.
A comprehensive yet simple solution that is economical and easy to use, would transform the current biopsy procedure into a `kit` that would enable surgeons and non-surgeons alike to perform the perfect biopsy.